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Caspofungin therapy in prosthetic valve endocarditis and candidemia due to itraconazole-resistant Candida glabrata (Nakaseomyces glabratus): A case report

Summary

A 13-year-old boy developed a serious fungal infection of his heart valve after surgery. The infection was caused by a resistant yeast that didn’t respond to initial antifungal treatment. Doctors used molecular testing to identify the exact fungal species and tested how it responded to different medications. After switching to a different antifungal drug called caspofungin, the patient recovered completely and remained healthy.

Background

Candidemia is a prevalent nosocomial bloodstream infection with high mortality rates up to 40%. Non-albicans Candida species, particularly Candida glabrata (Nakaseomyces glabratus), are increasingly reported and pose challenges due to limited diagnostic options and emerging antifungal resistance.

Objective

To present a case of a 13-year-old patient with prosthetic valve endocarditis and candidemia caused by itraconazole-resistant C. glabrata and demonstrate the effectiveness of caspofungin therapy combined with molecular identification and biofilm susceptibility testing.

Results

The isolate was resistant to itraconazole (MIC=8 µg/mL) but susceptible to amphotericin B and caspofungin. After switching from itraconazole to caspofungin (3 mg/kg/day) for 5 weeks, the patient achieved complete remission with no signs of relapse during 6-month follow-up.

Conclusion

Antifungal susceptibility testing on both planktonic and biofilm forms is valuable for identifying appropriate medications in Candida infections. Caspofungin may be an effective alternative treatment for C. glabrata endocarditis and bloodstream infections, even without surgical intervention.
  • Published in:Current Medical Mycology,
  • Study Type:Case Report,
  • Source: PMID: 41122117; DOI: 10.22034/cmm.2025.345248.1615
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